JessicaE :

Among those who don’t achieve a natural birth, almost across the board there is some complex medical factor at work, and those women tell me they felt empowered by the decision-making and the process, not guilty or defensive. And these women are very aware of the benefits of natural birth (including to bonding), but they also have tools to make a birth with unexpected interventions as mother- and baby-friendly as possible.

Jessica, thanks for your really thoughtful response. My intention was to point out that we are unlikely to effectively reach women if we only talk about the outcomes of care and diminish the processes of care that help produce those outcomes. I think your comment quoted above illustrates exactly what I meant – if women understand the six Healthy Birth Practices and are confident, informed, and empowered to demand these in labor, then if the outcome (needing drugs or surgery) doesn’t match up with what was hoped for, then they can (and often, though not always, do) take some comfort in knowing that they needed those interventions in order to safely give birth. And (the key point I was trying to make) they still reap benefits of those care practices, regardless of outcome. Continuous support is good for reasons other than that it reduces epidurals and operative delivery. Skin-to-skin contact after cesarean can mitigate some of the effect on bonding of surgical birth and the prolonged separation that often accompanies it. Likewise, I believe the other care practices may well enhance maternal and newborn health and wellbeing and promote mother-infant attachment, even when they don’t result in the desired “outcome” – unmedicated vaginal birth.

With all that said, *of course* we should stay focused on reducing epidural use and cesarean delivery. And part of doing that is being truthful with women about possible effects of epidurals, cesareans (and episiotomies, pitocin, etc. etc. etc.) on the physiology of mother-infant attachment, on breastfeeding, and on postpartum recovery. I intended to argue that we should not make this the sole focus of our work.

However, I take exception to the idea that we should not focus on outcomes. I’d like to challenge Lamaze, in fact, to take outcomes much more seriously. How will we ever know if we are making a difference in birth? To say, “let’s just spread our message, but not look at effectiveness because we don’t want anyone to feel badly” seems incredibly odd, to say the least.

I teach a natural childbirth class. We talked of course about an empowered, centered birth journey, wherever it leads… That birth is a force of nature, and most of the time it rains and snows and the wind blows within normal ranges, but very occasionally you get a flood, or a hurricane, or a tornado. And if those dramatic forces impact your birth, of course you need to seek the shelter of interventions. But I also teach NORMAL, NATURAL birth. And it works. Less than 15% of my students have c-sections. If they have a vaginal birth, over 90% do so without pain medication. Among those who don’t achieve a natural birth, almost across the board there is some complex medical factor at work, and those women tell me they felt empowered by the decision-making and the process, not guilty or defensive. And these women are very aware of the benefits of natural birth (including to bonding), but they also have tools to make a birth with unexpected interventions as mother- and baby-friendly as possible.

I would hate to see Lamaze “cop out” by saying that outcomes don’t matter, and we shouldn’t focus on them because the problems are just too big. Outcomes DO matter, and we must take responsibility for creating better ones. We can have a huge influence on choices, circumstances and system effects, and if we’re effectively teaching the six care practices, empowering women with solid information and advocacy tools, we should be seeing results.

I appreciate the forum for discussion, and hope that teaching with an eye toward outcomes might be a future evolution for Lamaze. I don’t think the organization can truly be a voice for normal, natural birth without that focus.

Jessica English, LCCE, CD(DONA)

This is one of my “hot” issues–the comments that are raised so often that imply that by not wanting a laundry list of interventions and routines a mother is choosing a “good experience” over a “healthy baby.” I think Lamaze’s 6 Healthy Birth Practices make it abundantly clear that the two go hand in hand!

Another nice post! Thanks!

Molly

Even though we don’t need science to tell us that natural birth is better for mother and baby – it’s nice to live in a time when science is starting to support it’s advocators and hopefully it will continue as so many parents today depend on it for guidance.